NHS Services (Access)
Debate between Dan Poulter and Kevin Barron(10 years, 2 months ago)
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Dr Poulter
If the hon. Lady has concerns about local commissioning decisions, she should take them up with local commissioners. Time forbids me from going into the rationing of services by the previous Labour Government. It is important that clinical services are now designed and delivered by front-line health care professionals, and if she is concerned about them, I am sure she will take that up with her local CCG.
The right hon. Member for Leigh (Andy Burnham) referred to a work force crisis in GP training. It is clear that under this Government 1,000 more GPs are now in training and working in the NHS than in 2010 when we came into government. If it is not accepted that that is good start, we have committed to training an extra 5,000 because we want more people working in general practice.
We have ensured that 1.3 million more people are being treated in A and E compared with the number in 2009-10. We have halved the time that people must wait to be assessed, and every day we are treating nearly 2,000 more people within the four-hour target compared with the number in 2010.
Competition was introduced into the NHS not by the Health and Social Care Act 2012 but by the previous Labour Government, of whom the right hon. Member for Leigh was a Minister. The Labour Government opened the door to private sector providers when they opened the first independent sector treatment centres in 2003. The Labour Government gave £250 million to private companies and independent sector treatment centres, regardless of whether they delivered that care. Labour was more concerned about giving money to the private centres than about ensuring that quality care was delivered. Labour paid independent private sector providers 11% more to provide the same care as NHS providers. That is Labour’s record on the private sector in the NHS—a record that shows that it is more committed to the private sector than any previous Conservative Government.
Kevin Barron
If that is the case, will the Minister—as a Back Bencher, he sat on the Health Committee—tell us why there were so many clauses in the Bill that introduced the Competition Commission and the Office of Fair Trading into our national health service?
Dr Poulter
The right hon. Member will be aware that Labour’s legislation, which gave the private sector the opportunity to tender for contracts, saw 5% of NHS activity—I believe that figure is correct—provided by the private sector at the end of the last Labour Government. In the Health and Social Care Bill, we wanted to stop the unregulated approach. We wanted greater emphasis on integration of health care services. It was not just about the private sector provider fixing someone’s hip and forgetting what sort of care was available when their hip had been repaired and they had gone home. It was about ensuring greater emphasis not just on competition and what was best for patients, but on integrated and joined-up services to ensure that people were properly looked after when they left a treatment centre. We stopped the cherry-picking of services that happened under Labour, and we are proud of that.
We will take no lessons from the Labour party on NHS finances. Labour was the party that crippled the finances of so many NHS trusts with PFI deals, and it was the party that during its final year in government saw the number of managers rise six times as fast as the number of nurses.
I am proud of this Government’s record on the NHS and I am proud of our record on integration. There will be a clear choice at the general election next year: a Conservative-led Government who have delivered for patients, a Conservative-led Government who have delivered on cancer services and a cancer drugs fund, and a Conservative-led Government who will continue to ensure better care for people with long-term medical conditions. We have a proud record on the NHS and I urge my right hon. and hon. Friends to oppose the motion.
Question put.
Francis Report
Debate between Dan Poulter and Kevin Barron(10 years, 9 months ago)
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Dr Poulter
We are leading by example. As I outlined, the Secretary of State has accepted the TSA recommendation in full. A process is now under way involving NHS England and local commissioners. That was initiated last week. It is important that those conversations happen and that an update is brought forward in a timely manner. That is the right thing to do. It is not appropriate to rush decisions and processes because of a political agenda, rather than an agenda of benefiting the local patients and women concerned. I am concerned as a doctor and as a Minister that we must do the best thing by patients. Rushed decisions are not always the best thing for patients, because conversations need to happen between local commissioners and NHS England. I hope that the hon. Lady will be a little patient, because I am sure that the right decision will be made in due course.
There are three key areas in which the Government have taken forward the recommendations of the Francis inquiry: encouraging a culture of transparency and openness in the health care system; empowering front-line staff and encouraging good leadership in the NHS; and putting the patient at the heart of everything that the NHS does. As we have discussed, the patient was not at the heart of everything that was done at Mid Staffordshire for a period. That is why we have to learn the lessons and ensure, as best we can, that that cannot happen again.
On transparency and openness, it is important to highlight how we have already delivered on the recommendations of Robert Francis’s report. The CQC has appointed three chief inspectors for hospitals, social care and general practice who will ensure not only that the organisation is complying with the law, but that the culture of the organisation promotes the benefits of openness and transparency. Importantly, we now have clinically led inspections for the first time, which means that people who really understand what good care looks like will be in charge of the inspection process. That clinical leadership in the inspection process and at the heart of what the CQC does has to be of benefit to patients, and the Government are proud that we have delivered that.
We have also introduced a new statutory duty of candour on providers, which will come into force this year. It will ensure that patients are given the truth when things go wrong and that honesty and transparency are the norm in every organisation.
Dr Poulter
The right hon. Gentleman might wish to intervene in a moment, but first I will respond to his good points on the importance of the duty of candour. There is some disagreement between us, because he said that there should be a duty on individuals. He will be aware from his time at the General Medical Council that there is already a duty on professionals to act in the best interests of patients and raise any concerns about the quality of care. As a body, the GMC has learned lessons from Mid Staffordshire and reviewed its processes, but it is important to recognise that many front-line professionals at Mid Staffordshire tried to raise concerns. The culture at the trust was such that those in management positions did not always listen to them. If we want to support whistleblowers and people’s ability to speak out freely for the benefit of patients, that has to be done at organisational level. Health care professionals are already under a duty through their professional obligations, which I hope reassures the right hon. Gentleman.
The right hon. Gentleman has been in the House for many years and will remember that problems of people not being able to speak out freely in their organisations date back to the Bristol heart inquiry. Professor Kennedy, who oversaw that inquiry, noted that it was the cultural problem in that hospital provider that prevented people from speaking out. The problem was not that people were not prepared to speak out—they recognised their professional obligations; it was that there was a wish at a senior level not to recognise problems. That is what we need to tackle. We are now almost 15 years on from the Kennedy inquiry into Bristol—I was a law student at Bristol university at the time—and the NHS has perhaps not learned the lessons that it needs to. I am sure that putting a duty of candour on to NHS organisations will begin to get us where we need to be.
Kevin Barron
Will the Minister consider what I said about how an independent statutory commissioner could examine complaints about patients’ care, as happens in New Zealand? Will he get back to me about whether he thinks that is a good idea? The people who work in the institutions that he is talking about have no faith that anything can be changed.
Dr Poulter
I will talk about complaints a little later, but the right hon. Gentleman has made some important points. When we consider how to improve the delivery of care in our health service, it is important that we examine international comparisons. The system in New Zealand includes a different form of compensation, and perhaps that is partly why it has a more open culture—there could be many other factors. It is acknowledged much earlier in the process that something has gone wrong, and there is a genuine attempt to explain the situation to the family and say sorry. That is what good health care is all about.
No matter how good, well trained and dedicated staff are, things will sometimes go wrong in a health service. When they do, it is important that we are open and honest with patients and that we do our best to put things right if we can, or explain and apologise if we cannot. That is why we believe that the duty of candour needs to exist at organisational level. Of course, I am happy to write to the right hon. Gentleman, or meet him if he would like to talk through some of the issues that he raised today. He makes good points, and I know that he does so on a completely apolitical basis because he has the best interests of the health service at heart. We might disagree on other issues, but on this one it is worth having a meeting to discuss his views further.
Subject to the passage of the Care Bill, a new criminal offence will be introduced to penalise providers who give false or misleading information where that information is required to comply with statutory or other legal obligations. It means that those directors or other senior individuals, including managers, who consent to, connive in, or are negligent regarding an offence committed by the provider could be subject on conviction to unlimited fines or even custodial sentences. We must ensure that managers and those running the health and care service in a health care provider provide information in an honest and transparent way that is always in the best interests of patients.
Importantly, we are introducing through the Care Bill a single failure regime to ensure that failure is not only about the financial sustainability of the trust, but about whether a health care provider is providing good care, and the quality of that care. One problem in the past with the trust special administration regime has been that it is rarely used. When it is used, however, it is important to ensure that it is there to protect patients. Often in the past it was used only in a way that focused on financial failure. One important lesson to learn from Mid Staffs is that there should be a failure regime that also considers quality of care. Hospitals are not just about good accounts; they are primarily about delivering good care, which is why we need a single failure regime. My right hon. Friend the Secretary of State has been a tremendous advocate for the importance of quality of care in trust, and he should be commended for that. Thanks to him, we are now ensuring that we improve the TSA regime in that way.
Mrs M. Barnes (NHS Treatment)
Debate between Dan Poulter and Kevin Barron(10 years, 10 months ago)
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The Parliamentary Under-Secretary of State for Health (Dr Daniel Poulter)
I congratulate the right hon. Member for Rother Valley (Kevin Barron) on securing the debate and commend him for all the work he has done on behalf of his constituent, and for the work he did in the previous Parliament, before I was a Member, as Chair of the Health Committee. I know that he has a long and distinguished record of fighting on health issues in the House, for his constituents and more generally. I also congratulate him on his recent knighthood. I am sure that the House will echo those congratulations.
We can all agree that good-quality patient care is expected, regardless of which part of the country we live in, and that all patients should expect it. I pay tribute to the NHS staff in the right hon. Gentleman’s constituency for the work that they do.
I am sorry to hear about the difficulties that Mrs Barnes has experienced and that she is dissatisfied with the quality of the care she has received. It is never acceptable for a patient to receive anything less than the very best treatment and service from our NHS. However, I am sure that all hon. Members will appreciate that the provision of local health care services is a matter for the NHS locally and that the Department of Health and Ministers do not play a role in directly investigating individual localised health care complaints, which should, quite rightly, be investigated without political interference to ensure that there is no question of bias. There is an NHS complaints procedure to resolve concerns and to help local NHS organisations to learn from the experiences of their patients. On the anniversary of the Mid Staffordshire scandal and the Francis inquiry, it is right that we reflect on the fact that we have to learn from things that have gone wrong in our health service and make sure we put them right for the benefit of future patients.
I understand that, as the right hon. Gentleman outlines, Mrs Barnes has been pursuing this matter for many years and has made use of the NHS complaints system, up to and including the health service ombudsman, on a number of occasions. I also understand—this is an important point in the context of the ombudsman and other issues—that a number of the concerns that Mrs Barnes raises about her care relate to events involving non-NHS health care. I should make it clear that what I say relates to the NHS, and not to health care providers working outside the NHS with whom Mrs Barnes may have decided to undertake treatment.
It is relevant at this stage to say a few words about how the ombudsman system works.
Kevin Barron
I accept, to some extent, the Minister’s point about the wider issues, which were not a matter of referral to the ombudsman. However, a constituent might often go to the private sector needing to get things done because they are in pain, for example, and might then see a consultant they could also see under the NHS. Often the staff are the same people, and there is no great difference between the clinicians they meet. Does he agree with that?
Dr Poulter
The right hon. Gentleman is absolutely right. It is difficult, in terms of the care pathway, for any patient to draw these distinctions. However, the NHS complaints procedure relates to NHS care, and the ombudsman’s role is as a public sector ombudsman. That goes to the heart of some of the difficulties we are talking about.
If a complainant is dissatisfied with the outcome of their complaint locally, they have the right to take it to the health service ombudsman, whose office was set up under the Health Service Commissioners Act 1993. When complaints are escalated, it is important that they are investigated independently, free from the political process, to ensure that there is no question of bias. The health service ombudsman is completely independent of the Department of Health, the Government, and the NHS. It is therefore difficult for me to comment on the ombudsman’s decisions directly.
If a complainant is dissatisfied with the ombudsman’s decision, they may make use of her own complaints process. The recourse open to anyone after the ombudsman has made a final decision is to seek a judicial review. During the entire complaints process, we assume that patients would take legal advice whenever they think it necessary. That is in their best interests and, in some cases, it is often important that patients have advice from a completely independent source.
If, on the basis of the legal advice received, patients decide to commence legal action against the NHS, that is, of course, to be expected. The House will understand that I cannot comment on legal advice given to patients, including Mrs Barnes, as that is entirely a matter between the patient and her lawyer. Complaints about lawyers are not a matter for the Department of Health or the NHS, nor for this House to consider in this context. I am aware that Mrs Barnes has exhausted all the legal remedies open to her. Her case has been considered by a number of courts, including the Court of Appeal, and has on each occasion been rejected. It goes without saying that these matters will have been considered carefully by the various judges involved, and I should not and will not cast any doubt on their judgments.
Dr Poulter
My hon. Friend will be aware that patients have open access to their records and can request to see them, but it is not for a patient forcibly to remove relevant clinical information from them. I am not sure whether that was the case in these particular circumstances, but I hope to be able to reassure the right hon. Member for Rother Valley.
It is worth pointing out that, during the long line of litigation, in 2007 Mr Justice Simon said, following a hearing, that
“this is not a case of professional conspiracies by the medical or legal professions; it is a case where the balance of the evidence before the Court fell decisively and conclusively in favour of the defendant”,
meaning the NHS. There is a long history of legal rulings that make that point clearly. Indeed, I understand that the NHS Litigation Authority obtained cost orders in its favour for that case, although it was unable to recover its costs. I reassure the right hon. Gentleman, however, that I shall look into the issues he has raised about the ombudsman and the Information Commissioner and write to him about them.
Kevin Barron
I appreciate that. I know that there is some history to the case of Mrs Barnes, but in my humble view—I understand that the ombudsman and politicians should not get mixed up—this specific issue is not about what happened in the courts. It is about what did or did not happen at the request of the Information Commissioner. My reading of the situation is that it could have been managed and handled by the health service ombudsman and compensation could have been paid. In my view, the ombudsman sat back, possibly because of the history to which the Minister has just referred, and thought, “It’s got to go to litigation and that’s it.” When other avenues were closed off, the ombudsman’s office could have managed the situation, but it seems to me that it backed off, looked at the whole history of the case of Mrs Barnes and said that it had to go to litigation. I think that is unfair and that the ombudsman’s office could have handled things much better and smarter on behalf of my constituent.
Dr Poulter
I note what the right hon. Gentleman says. I have committed to looking further into the issue and to writing to him, and I hope that will reassure him further about the processes that have been followed in this case.
As I said at the outset, I am very sorry to hear that Mrs Barnes is unhappy at the care and treatment she has received from the NHS. I am also aware that, over the years, she has been seen and treated in a private capacity on a number of occasions, which, as we have discussed, complicates the issues, because it can make it difficult to establish whether the responsibility sits with the NHS—as part of either the ombudsman’s process or the NHS complaints procedure—or elsewhere. Her case has also been considered by the courts on a number of occasions and I have alluded to their conclusions.
I understand that Mrs Barnes made full use of the various NHS complaints processes, but remains dissatisfied, which we have discussed in detail today. Accordingly, she has involved the health ombudsman, but the outcome has not been as she would have wished.
As I have said—this is worth repeating—the ombudsman is independent of Ministers, the Department of Health and the Government. An option open to anyone dissatisfied with the ombudsman’s actions is judicial review, but it is not to be embarked on lightly and those considering doing so should ensure that they take legal advice.
I wish Mrs Barnes well and I appreciate the intentions of the right hon. Gentleman and his strong advocacy of her case.
Question put and agreed to.